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Item does not contain fulltext, PURPOSE: To prospectively evaluate the diagnostic performance of magnetic-resonance-arthrography (MRA) by experienced musculoskeletal radiologists in patients with traumatic-anterior-shoulder-instability (TASI), after feedback protocol execution. MATERIALS AND METHODS: Forty-five surgically confirmed MRA's were used to enhance personal feedback, to discuss differences in outcome between MRA assessment and surgical findings and to fine-tune definition interpretation agreement of 7 different TASI-related lesions, between experienced musculoskeletal radiologists and experienced orthopaedic shoulder surgeons. After execution of the feedback protocol 20 new, surgically confirmed, MRA's were assessed by 2 experienced musculoskeletal radiologists using a seven-lesion standardized scoring form. Kappa coefficients, sensitivity, specificity, and differences in percentage agreement or correct diagnosis (p-value, McNemar's test) were calculated per lesion and overall per 7 lesion types to assess whether diagnostic reproducibility and accuracy was improved. RESULTS: Per 7 lesion types, the overall kappa and percentage of agreement, between the 2 radiologists, were dramatically increased in comparison with our former study (k=0.81 versus k=0.48 and 90.7% versus 78.2%, respectively). The overall sensitivity of radiologist 1 increased from 45.9% to 87.8%, the overall sensitivity of radiologist 2 increased from 63.5% to 79.6% and the overall specificity of radiologist 2 increased from 80.1% to 85.7%. Furthermore, the overall percentage of correct diagnosis of both radiologist was also exceedingly higher (85.7% and 83.6%) compared to our former study (74.4% and 74.8%). CONCLUSION: The implementation of our feedback protocol dramatically improved the reproducibility and accuracy of high field MRA by experienced musculoskeletal radiologist in patients with traumatic anterior shoulder instability.

1 juni 2012, Item does not contain fulltext, INTRODUCTION: Patient satisfaction becomes more important in our modern health care system. The assessment of satisfaction is difficult because it is a multifactorial item for which no golden standard exists. One of the potential methods of measuring satisfaction is by using the well-known visual analogue scale (VAS). In this study, we validated VAS for satisfaction. PATIENT AND METHODS: In this prospective study, we studied 147 patients (153 hips). The construct validity was measured using the Spearman correlation test that compares the satisfaction VAS with the Harris hip score, pain VAS at rest and during activity, Oxford hip score, Short Form 36 and Western Ontario McMaster Universities Osteoarthritis Index. The reliability was tested using the intra-class coefficient. RESULTS: The Pearson correlation test showed correlations in the range of 0.40-0.80. The satisfaction VAS had a high correlation between the pain VAS and Oxford hip score, which could mean that pain is one of the most important factors in patient satisfaction. The intra-class coefficient was 0.95. CONCLUSIONS: There is a moderate to mark degree of correlation between the satisfaction VAS and the currently available subjective and objective scoring systems. The intra-class coefficient of 0.95 indicates an excellent test-retest reliability. The VAS satisfaction is a simple instrument to quantify the satisfaction of a patient after total hip arthroplasty. In this study, we showed that the satisfaction VAS has a good validity and reliability.

Samenvattingen behorende bij de 82e bijeenkomst gehouden op 8 april 2010 bij het NIOO in Heteren: invloed van aan afweergerelateerde signaaltransductie op de bacteriële rhizosfeermicroflora van Arabidopsis thaliana, de bodem onder biologische grondontsmetting, effecten van koolvariëteiten met verschillende glucosinolatengehaltes op planten-parasitaire nematoden en ondergrondse niet-doelorganismen. Klimaat geïnduceerde areaaluitbreidende planten ondervinden minder ondergrondse en bovengrondse effecten van natuurlijke vijanden.

Contains fulltext : 53613.pdf (publisher's version ) (Closed access), Allografts of bone from the femoral head are often used in orthopaedic procedures. Although the donated heads are thoroughly tested microscopically before release by the bone bank, some surgeons take additional cultures in the operating theatre before implantation. There is no consensus about the need to take these cultures. We retrospectively assessed the clinical significance of the implantation of positive-cultured bone allografts. The contamination rate at retrieval of the allografts was 6.4% in our bone bank. Intra-operative cultures were taken from 426 femoral head allografts before implantation; 48 (11.3%) had a positive culture. The most frequently encountered micro-organism was coagulase-negative staphylococcus. Deep infection occurred in two of the 48 patients (4.2%). In only one was it likely that the same micro-organism caused the contamination and the subsequent infection. In our study, the rate of infection in patients receiving positive-cultured allografts at implantation was not higher than the overall rate of infection in allograft surgery suggesting that the positive cultures at implantation probably represent contamination and that the taking of additional cultures is not useful.

Contains fulltext : 52742.pdf (publisher's version ) (Open Access), BACKGROUND: A medialization of the femoral component in a total knee arthroplasty (TKA) causes abnormal patellar tracking, which could result in patellar instability, pain, wear, and failure. Previous reports defined medialization in relation to the neutral position of the femoral component, but omitted to compare it to the anatomical position of the trochlea. We assessed intraoperatively whether there is a systematic error of the position of the prosthetic groove relative to the anatomical trochlea. MATERIAL AND METHODS: A special instrument was developed to measure consecutively the mediolateral position of the anatomical trochlea and the mediolateral position of the prosthetic groove. 3 experienced knee surgeons determined the mediolateral error of the prosthetic groove in primary TKAs in 61 patients. RESULTS: There was a significant medial error of the prosthetic groove relative to the preoperative position of the trochlea, with a mean medial error of 2.5 mm (SD 3.3) INTERPRETATION: Our findings indicate that the trochlea is medialized by TKA. Because a conscious medialization of the femoral component in a TKA produces abnormal patellar tracking patterns, further investigations will be needed to analyze the clinical consequences of this medialization of the trochlea.

Item does not contain fulltext, Trochlear dysplasia is a predisposing factor for recurrent patellar instability. We evaluated the results of an anterior lateral femoral condyle open wedge osteotomy for treating patellar instability. A total of 16 consecutive patients (19 knees) with symptoms of recurrent patellar instability and trochlear dysplasia identified using a true lateral radiograph of the knee underwent an anterior lateral femoral osteotomy. Outcomes were documented at 2 years minimum follow-up using the Lysholm scale, the patellofemoral score, WOMAC score and standard conventional radiographs. In 17 knees, patients reported good improvement in stability (no dislocations) and most patients had a marked improvement in pain and functional scores at follow-up (mean follow-up 51 months). No serious complications occurred. Anterior femoral osteotomy of the lateral condyle appears to be a satisfactory and safe method for treating patients with patellofemoral joint instability caused by trochlea dysplasia. In selected cases this procedure can be used to correct trochlea dysplasia. In our opinion, the key to a successful treatment of patellofemoral instability is to successfully distinguish the anatomic deficiencies and to correct the anatomical abnormality.

Item does not contain fulltext, INTRODUCTION: The most common treatment of enchondromas is curettage (with or without adjuvant therapy) followed by cancellous bone grafting. To avoid donor-site morbidity of the iliac crest, we applied plaster of Paris as a bone defect filler after curettage of enchondromas. MATERIALS AND METHODS: We treated 19 enchondromas of the hand and foot in 19 patients (mean age 40 years, range 21-79 years) with curettage and filling of the cavity with sterile plaster of Paris (calcium sulphate/phosphate) tablets. RESULTS: The diagnosis was histologically confirmed in all cases. After a mean follow-up of 53 months (range 15-139 months), the mean functional Muskuloskeletal Tumor Society Score was 29.1 points (97%; range 28-30). There were no local recurrences although adjuvant therapy was not utilized. CONCLUSION: Plaster of Paris appears safe and effective as a bone-filling substance after curettage of enchondroma.

Item does not contain fulltext, We analyzed the difference in angle-correction accuracy and initial stability between open-wedge (OWO) and closed-wedge tibial valgus osteotomy (CWO). Five fresh-frozen pairs of human cadaver lower limbs were used; their bone mineral density (BMD) was measured with DEXA and a planned 7 degrees valgus osteotomy was performed, either with an open (right knees) or closed (left knees) technique. All knees for osteotomy were fixed with a rigid locked plate. In OWO, tricalcium phosphate (TCP) wedges were inserted. The knees were subjected to an increasing cyclic axial load until failure, while measuring the relative displacement of the bony segments with roentgen stereophotogrammetric analysis. The mean postoperative valgus correction angle was 9.5 degrees +/-2.8 degrees for CWO (over-correction of 2.5 degrees ) and 6.2 degrees +/-2.0 degrees for OWO (under-correction of 0.8 degrees ) (P =0.08). The data of displacement under load bearing showed no significant differences in rotations and translations in any direction. No significant correlation between BMD and the moment of failure was found (P =0.27). This study has shown that both methods gave an acceptable correction with a high variation of postoperative correction angles. There was a tendency for over-correction in the CWO group but no significant difference was found. There was no difference in initial stability between CWO and OWO with a rigid locked-plate fixation.

Contains fulltext : 58286.pdf (publisher's version ) (Closed access), INTRODUCTION: We performed a clinical follow-up study to investigate whether three orthopaedic surgeons were equally satisfied after total knee arthroplasty (TKA). PATIENTS AND METHODS: Thirty-six patients (39 TKAs, mean follow-up 12 months) were reviewed, using the Knee Society Clinical Rating System (KSCRS). For the assessment of satisfaction a visual analogue scale (VAS) was used. RESULTS: We did not find a significant difference in satisfaction between the surgeons. However, there was a significant difference in the knee score and function score of the KSCRS as evaluated by the orthopaedic surgeons (p=0.006 and p=0.04, respectively). The correlation between the knee score and the surgeons' satisfaction was high, which indicates that pain, range of motion and deformity are important success criteria for surgeons. CONCLUSIONS: In this study, surgeons scored differently in the KSCRS but were equally satisfied after TKA.

Item does not contain fulltext, We evaluated the outcome of open antero-inferior capsular shift in 17 patients with multidirectional instability of the shoulder who failed to respond to conservative treatment. Six shoulders presented with secondary impingement syndrome and 11 with involuntary instability. The mean duration of follow-up was 39 months (range 7-89 months). Based on the Rowe and Constant scores and the 12-item questionnaire of Dawson, the results were rated excellent in 14 patients, fair in 2 and poor in 1. All but 2 patients were satisfied with the results, although 6 patients experienced some residual pain, and 4 suffered minor instability. There were no neurovascular complications, infections or symptomatic posterior instability. Open antero-inferior capsular shift yields promising short-term to medium-term results in multidirectional, involuntary instability of the shoulder.

Item does not contain fulltext, The bone mineral density (BMD) of the distal femur may decrease after cemented total knee arthroplasty (TKA) as a result of the stress shielding effect of the femoral component. The purpose of the study was to determine the changes in BMD of the distal femur compared with those of the femoral necks and the lumbar spine after cemented TKA. BMD of two regions of interest in the distal femur, both femoral necks and the lumbar spine was measured with dual-energy X-ray absorptiometry in 10 patients (age range 41-80 years, mean 62 years) with 12 TKAs preoperatively and during follow-up for 1 year after surgery. The hip and spine measurements were performed for comparison to assess if general changes in BMD occurred after TKA. The median decrease in BMD in the region behind the anterior flange of the femoral component was 22% (95% CI: 12%-33%), while the average decrease in the region just above the femoral component was 8% (95% CI: 2%-13%). The difference in change of BMD between both regions before and 1 year after TKA was significant (p = 0.03).We found less than 1% difference in BMD of both femoral necks and the lumbar spine on average between the preoperative and 1 year follow-up measurements (not significant). A significant periprosthetic distal femoral bone resorption occurred after TKA. BMD of the femoral necks and lumbar spine did not differ 1 year after TKA.

Katholieke Universiteit Nijmegen, 8 juni 2000, Promotor : Veth, R.P.H. Co-promotores : Waal Malefijt, M.C. de, Buma, P., Verdonschot, N.J.J., Item does not contain fulltext

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